The Essentia Health Community Cancer Research Program (EHCCRP) was originally funded by the National Cancer Institute in 1984 under the former name Duluth CCOP. EHCCRP brings the benefits of clinical research to patients in regions that would be without access to clinical trials due to the distance from the nearest comprehensive cancer center. With successful competitive CCOP grant renewals in 1987, 1990, 1995, 2000, 2005 and 2010, EHCCRP has a proven long-term track record in running an oncology research program. Since the last competitive CCOP grant renewal in 2010, the EHCCRP has expanded to additional component sites and now includes parts of four states (MN, Wl, ND, SD) within the patient catchment area. This large geographic area is predominantly rural and includes a number of Native American tribal communities. The strategy of the EHCCRP NCORP is to continue to offer patients in the region access to state-of-the-art cancer care through participation in NCI supported treatment and cancer control/prevention protocols. The NCORP grant will support the infrastructure and personnel necessary to fulfill our proposed research strategy. In addition, the EHCCRP NCORP will allow the development of a robust Cancer Care Delivery Research (CCDR) program based at the lead site component in Duluth, MN, to participate in NCI supported CCDR protocols. The Alliance for Clinical Trials in Oncology will function as the primary research base for the EHCCRP and secondary research bases will include the NRG and ECOG-ACRIN. The EHCCRP NCORP will continue to open trials through the Clinical Trials Support Unit of the NCI. Children have access to Children's Oncology Group studies via an affiliation between EHCCRP pediatric hematologists/oncologists and the University of Minnesota. The goal of the EHCCRP is to accrue 200 patients annually to treatment, cancer control, prevention, screening and post-treatment surveillance protocols. A robust culture of cancer care that supports multi-disciplinary treatments allows us to deliver the best possible therapy while maintaining a high level of accrual to clinical trials.